I just got an email message from my new concierge doctor. He
writes that the likelihood of me contracting covid-19 is small and that none of
his patients have thus far come down with the viral illness. He urges those of
us in his practice to continue to wear masks, practice social distancing, and
wash our hands frequently. In other words, he is urging good sense and care as
we try to come to grips with a world that has changed dramatically over the
last few months, but is trying to get back to business in some fashion.

What his note reflects is two realities. First, the novel
coronavirus that emerged from Wuhan, China will be with us for the foreseeable
future. This will be true even if a miracle treatment is found and surely until
a deployable, effective vaccine is developed. Second, the world needs to get
back to business again. It will not be business as usual. I personally do not
see going to a concert, sporting event, or convention any time soon. I am still
reticent to get on an airplane and I am not rushing to dine in a restaurant,
even though many are now open and serving clientele. This is reality. I am in
the high-risk age group. I choose not to tempt fate for a high-priced plate of
pasta.

What is the reality of academic medicine?

At centers like MD Anderson, so dependent on patient flow
from places outside of Houston, it is likely that patient volumes will remain
low until people feel comfortable getting back on planes. Hopefully, the
restrictions on in-patient numbers will be relieved and at least necessary
local admissions and “elective” cancer surgery can resume, even if that too is
mostly for local patients.

I have recently learned that most of the staff of Anderson currently
working from home is expected to stay there for the next two months. This would
include much of the administrative and research staff of the cancer center. It
will be difficult to ramp up vital research from kitchen tables.

Note was taken in the Wall
Street Journal today (May 5) of this precise issue.

This piece by Dr. Kevin Sheth of Yale notes the need to get
research back up again, especially clinical trials, many of which have been
halted as support staffs have been sent home and the interpersonal proximity
needed for good clinical research was deemed too risky. For patients with
serious ailments whose only hope may be clinical trials, the risk is not doing
the research. And by the way cancer cannot wait for a coronavirus vaccine, nor
can cancer surgery and out-patient visits let alone cell therapy and radiation.

I am pretty sure that we have a sufficient bead on the
coronavirus to know several key things.

Yes, it is highly contagious and is transferred from
person-to-person.

Yes, masks can help minimize this risk and it may well be
that more disease is being transmitted within households than outside of them.

Yes, biomedical research is a key component of the academic
mission of most medical centers and it cannot be done from home. We are giving
up a great deal keeping large swaths of investigators and technical personnel at
home. How wise is that?

Yes, there are ways to work shifts, sanitize work spaces,
and even meet in person to advance the cause of science. After all, the solution
to the coronavirus problem may rest in a discovery from a lab that does cancer
research so shutting all those labs down makes no sense.

There must be a way to continue the educational missions of
academic centers as well. Much learning cannot take place at a distance. Surely
this is true of learning clinical medicine, but is also true of performing
research.

Getting back will take some innovation. We will not be going
back to the pre-corona world. Our behaviors must change and the way we do business
will as well. However, that does not make the academic missions of clinical
care, research, and education less important than they were two months ago.
Their pursuit may require the very creativity in which academics take pride.
Let’s put that to work and figure out a way to open the labs and continue
educating students, post-docs and residents while maintaining safety. It can be
done. Many places are doing it. All should.

There are those proposing a normalization of working from
home, something that has happened in many industries already. I do not believe
that patient care, biomedical research, or post-graduate education are
industries in which working from home advances progress. The suggestion that a
more permanent move to working at home is a good idea and part of the future of
an academic center is, quite frankly, absurd. Anyone who has had his or her
fill of Zoom meetings longs for face-to-face (even if it is mask-to-mask)
contact with collaborators, students and colleagues. Before we adapt ourselves
into oblivion, let’s consider becoming more creative with our work, but let’s
agree that that work is in the hospital, clinic, labs, and classrooms of
American biomedical research.

We need to find a way to get back even if it is a new
normal. Sixty days more of this is not a good idea.